FCAAIA Notes: The best test for diagnosis of food allergy is a thorough history as to what happens with ingestion. Tests for food allergy can help confirm or refute a diagnostic suspicion (which means the physician needs to have a diagnostic suspicion before doing the test). The results are not “black and white” but require interpretation in the context of the patient’s history. A positive does not mean you have allergy. If you do not have symptoms with ingestion you are not allergic. Continue reading “FOOD ALLERGY: CONSENSUS REPORT STRESSES DIAGNOSTIC ACCURACY”
FCAAIA Notes: Of all the medications out there, the one for which we have the best data about how to interpret testing is penicillin. If your testing to penicillin and a metabolite of penicillin (Pre-Pen®) is negative, there is up to a 95% chance you do not have an immediate-type allergy to penicillin, even if you have a strong history suggesting allergy). The several percent “false-negative” are probably allergic to other metabolites (minor determinant mixture, MDM). Patients who had severe allergic reactions to penicillin are sometimes allergic to MDM, creating a bit of a quandary. So, we often eliminate that last 5+% by doing an observed in-office challenge to penicillin in patients with negative skin testing. Continue reading “TESTING PENICILLIN ALLERGY CUTS WIDE-SPECTRUM ANTIBIOTIC USE”
FCAAIA Notes: The vast majority of children with asthma have allergies and should have allergy testing. Therefore, a thorough history of environmental exposures, correlated with the patient’s history and his testing results allow for focused recommendations for allergen avoidance.
The role of allergy in asthma is so well established that national and international guidelines for the care of asthma indicate that patients with persistent asthma (and allergy) should be considered candidates for allergy shots. Continue reading “AAP: INDOOR ALLERGEN TESTING ‘A MUST’ FOR KIDS WITH ASTHMA”
FCAAIA Notes: There are a few important points in this article. First a positive test does not necessarily mean allergy. Anyone can have a positive test to anything and not be allergic. You are not actually allergic unless you also have a reaction with exposure. A positive test without allergy is called sensitization (as was the case in 53% of these children). Second, specific allergies are not inherited as much as the tendency to develop allergy. That is why the researchers tested to a battery of foods rather than just the food to which the older sibling was allergic. Finally, most younger siblings of food allergic children were NOT allergic to any food.
I understand the anxiety that a second child might also be allergic Continue reading “FALSE POSITIVES COMMON IN SIBLINGS OF FOOD-ALLERGIC CHILDREN”